Provider Demographics
NPI:1528711033
Name:HARRELL, ZACHARY EVAN (CADCR, QMHA)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:EVAN
Last Name:HARRELL
Suffix:
Gender:M
Credentials:CADCR, QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 NE MARTIN LUTHER KING JR BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-2086
Mailing Address - Country:US
Mailing Address - Phone:503-206-8856
Mailing Address - Fax:
Practice Address - Street 1:3311 NE MARTIN LUTHER KING JR BLVD STE 104
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-2086
Practice Address - Country:US
Practice Address - Phone:503-206-8856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)